MEDICARE: ELLA KISSI PHAMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03442334	OH

General Provider Information

NPI Number	:	1316674104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA KISSI PHAMD

Provider Business Mailing Address
First Line	:	2430 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2736
Country	:	US
Telephone Number	:	419-381-6981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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Directions to “ ELLA KISSI PHAMD” Practice Location

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